Despite significant advances in the therapy of heart failure, cardiac transplantation presently provides the only means of survival for patients with severe disease refractory to medical therapy. With the increasing number of candidates and the limited supply of donor organs, it has become increasingly important to identify individuals with the poorest and best prognoses. The work envisioned in this proposal will lead to the development of a multivariate predictive model of one- and two-year actuarial survival, using prospectively collected data on over 500 patients with moderate and severe heart failure referred to the University of Pennsylvania's Heart Failure Evaluation Center. This model will be applied to the development of a clinical predictive index, providing a practical, reliable, and discriminating method of identifying patients at risk for early mortality, thereby facilitating optimal selection of transplant candidates. Prospective validation of the model will be performed using a second independent sample from the University of Pennsylvania, and an independent sample drawn from other major cardiac transplant centers. The product of this research will contribute to improved management of patients with severe heart failure and to the efficient use of scarce medical resources.